canceristreated,andthen,ifallgoeswell,thesecosts
taperoff.A 2011 study,forinstance,foundthatmedical
spendingfora breastcancer patientin thefirstyearof
diagnosis averaged an estimated $28,000, the vast
majorityofitfortheinitialdiagnostic testing,surgery,
and,wherenecessary,radiationandchemotherapy.Costs
fellafterthattoabout$2,000ayear.Forapatientwhose
cancerprovesfatal,though,thecostcurveisU-shaped,
risingtowardtheend—toanaverageof$94,000during
thelastyearoflifewithametastaticbreastcancer.Our
medicalsystemisexcellent attryingtostaveoffdeath
with $12,000-a-month chemotherapy, $4,000-a-day
intensive care,$7,000-an-hour surgery. But,ultimately,
death comes, and few are good at knowing when to stop.
While seeinga patientin anintensive care unitatmy
hospital,Istoppedtotalkwiththecriticalcarephysician
onduty,someoneI’dknownsincecollege.“I’mrunning
awarehouseforthedying,”shesaidbleakly.Oftheten
patients in her unit, she said, only two were likely to
leave thehospital foranylength oftime.Moretypical
wasanalmosteighty-year-oldwomanattheendofher
life,withirreversiblecongestiveheartfailure,whowasin
theICUforthesecondtimeinthreeweeks,druggedto
oblivionandtubedinmostnaturalorificesaswellasa
fewartificialones.Ortheseventy-year-oldwithacancer
thathadmetastasizedtoherlungsandboneandafungal
pneumonia that arises only in the final phase of the
illness. She had chosen to forgo treatment, but her
oncologistpushedhertochangehermind,andshewas
putonaventilatorandantibiotics.Anotherwoman,inher
eighties, with end-stage respiratory and kidney failure,
hadbeenintheunitfortwoweeks.Herhusbandhaddied